Issue - items at meetings - A&E and Capacity Pressures at the Royal Sussex County Hospital

76.1         Elma Still, Associate Director, Quality, BSUH, Sherree Fagge, Chief Nurse, BSUH and Geraldine Hoban, Chief Operating Officer, Clinical Commissioning Group (CCG), presented the report updating HWOSC members on progress against the five workstreams put in place at the emergency department following the ECIST inspection and report.

76.2         Ms Fagge wanted to assure people that the figures circulated related to all emergency services in RSCH including the children’s emergency department; everyone was seen in four hours or less. Ms Fagge was aware that adults with special educational needs were flagged up when they attended A&E and will follow up and confirm if this was the case for children.

76.3         There had been local news coverage of the negative Care Quality Commission inspection and report recently; this was not a new inspection but had taken place when the department was in crisis. If the Care Quality Commission inspectors were to return now, the hospital is confident that they would see a very different picture.

76.4         Ms Hoban spoke on behalf of the CCG; they were keeping a close eye on progress at A&E. The summer period tended to have lower demands on emergency services so it was a good time to review pathways of care and discharge arrangements. It was true that the situation had improved at A&E but all parties recognised that there was still a great deal to do.

76.5         Ms Hoban also commented that the CCG had monthly meetings with the Care Quality Commission, reviewing the metrics that they were assessing.

76.6         Members asked why the Care Quality Commission had just come to light, given that the inspection took place in April.

Ms Fagge confirmed that although the assessment was in April, the report had not been published until June. The report focussed on four areas of concern, three of which were about overcrowding in A&E. The fourth area for improvement was staff training; a large piece of work was being organised to address training needs.

76.7         Members said that emergency services were so stretched because the wrong people were using A&E; not everyone who was there needed to be there.

It would also be better to have a separate area for people with drink and drug issues, as these people caused lots of trouble for other attendees. The 111 service had received a lot of poor publicity and was not giving people confidence that it would give appropriate and timely advice.

Ms Fagge said that they had to care for all of the people who came through the doors. However it was true that not everyone who was at A&E should be there. The CCG was currently running a poster campaign to highlight alternatives to A&E including the out of hours service, drop in clinics etc.

There was now a GP on the front door of A&E; they are able to see people straight away and direct them to the most suitable care provider.

Ms Hoban said that there was a dedicated room for people with mental health needs in crisis; this has been very successful at reducing the number of admissions. The CCG will look at how to address people with drug and alcohol issues, and whether this can be handled in a similar way.

76.8         Members said that they welcomed the campaign to promote alternatives to A&E as long as it did not have the adverse effect of stopping people who should be at A&E from attending.

Ms Hoban said that, when it was fully operational, the 111 service would be the gateway for knowing when A&E was appropriate. Extra investment was going into the 111 service for increased number of staff and clinical services in local call centres.

76.9         Members said that they had felt reassured by Matthew Kershaw’s presentation at the last HWOSC and remained reassured by this update. They noted that A&E had accepted that there had been faults and had put in plans to address them. Would it be possible for BSUH and the CCG to consider what other factors might be affecting A&E performance so that HWOSC can put on pressure where necessary. For example, are there delays in adult social care, are some people not used to using GP services etc.

The Chair agreed that it would be good to see detail of all of the determining factors and causes. It was pleasing to see that there was already evidence of progress – as the Hospital Trust had already identified, it would be key to determine whether the positive trend would continue. The report was due to return to HWOSC in September for a further update and review.